U.S. patent application number 13/127288 was filed with the patent office on 2011-11-17 for increased expression of specific antigens.
Invention is credited to Lisa Bandholtz, Asa Karlsson, Nikolai Kouznetsov, Oliver Von Stein, Petra Von Stein, Arezou Zargari.
Application Number | 20110280934 13/127288 |
Document ID | / |
Family ID | 42153090 |
Filed Date | 2011-11-17 |
United States Patent
Application |
20110280934 |
Kind Code |
A1 |
Karlsson; Asa ; et
al. |
November 17, 2011 |
Increased Expression of Specific Antigens
Abstract
The response of immunotherapy in the treatment of cancer is
enhanced by use of an oligonucleotide in a dose effective to induce
at least one of endogenous production of cytokines, and the
regulation of the expression of one or more of the cell surface
antigens (FIG. 1).
Inventors: |
Karlsson; Asa; (Sollentuna,
SE) ; Bandholtz; Lisa; (Stockholm, SE) ;
Kouznetsov; Nikolai; (Jarfalla, SE) ; Von Stein;
Oliver; (Upplands Vasby, SE) ; Von Stein; Petra;
(Upplands Vasby, SE) ; Zargari; Arezou; (Solna,
SE) |
Family ID: |
42153090 |
Appl. No.: |
13/127288 |
Filed: |
November 3, 2009 |
PCT Filed: |
November 3, 2009 |
PCT NO: |
PCT/SE2009/051244 |
371 Date: |
July 25, 2011 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
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61111288 |
Nov 4, 2008 |
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61111292 |
Nov 4, 2008 |
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61111293 |
Nov 4, 2008 |
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Current U.S.
Class: |
424/450 ;
424/173.1; 424/184.1; 424/277.1; 536/23.1 |
Current CPC
Class: |
A61K 31/7125 20130101;
C12N 2310/313 20130101; A61P 35/00 20180101; C12N 2310/17 20130101;
A61K 45/06 20130101; A61P 37/02 20180101; A61P 25/00 20180101; A61P
37/04 20180101; A61K 39/3955 20130101; C12N 2310/315 20130101; C12N
15/117 20130101; A61K 2039/55561 20130101; A61K 31/7125 20130101;
A61K 2300/00 20130101; A61K 39/3955 20130101; A61K 2300/00
20130101 |
Class at
Publication: |
424/450 ;
536/23.1; 424/184.1; 424/277.1; 424/173.1 |
International
Class: |
A61K 9/127 20060101
A61K009/127; A61K 31/7125 20060101 A61K031/7125; A61P 37/04
20060101 A61P037/04; A61P 35/00 20060101 A61P035/00; A61P 25/00
20060101 A61P025/00; C07H 21/04 20060101 C07H021/04; A61K 39/395
20060101 A61K039/395 |
Foreign Application Data
Date |
Code |
Application Number |
Nov 4, 2008 |
SE |
0802335-0 |
Nov 4, 2008 |
SE |
0802336-8 |
Nov 4, 2008 |
SE |
0802337-6 |
Claims
1-23. (canceled)
24. An isolated and substantially purified oligonucleotide selected
from the group consisting of SEQ ID NO: 1-6, wherein at least one
nucleotide has a phosphate backbone modification, said phosphate
backbone modification chosen from a phosphorothioate or a
phosphorodithioate modification.
25. A pharmaceutical composition comprising an oligonucleotide
according to claim 24.
26. A pharmaceutical composition comprising an oligonucleotide
according to claim 24, and further comprising a pharmacologically
compatible and physiologically acceptable excipient or carrier
selected from the group consisting of saline, liposomes,
surfactants, mucoadhesive compounds, enzyme inhibitors, bile salts,
absorption enhancers, cyclodextrins, and combinations thereof.
27. A method for enhancing a treatment of a condition wherein CD20
expressing cells participate in the pathogenesis of said condition,
wherein an oligonucleotide selected from the group consisting of
SEQ ID NO: 1-6, or a pharmaceutical composition comprising said
oligonucleotide, is administered in a dose sufficient to induce an
up-regulation of the cell surface antigen CD20, and wherein said
oligonucleotide is administered before said treatment.
28. A method according to claim 27, wherein the oligonucleotide is
selected from the group consisting of SEQ ID NO: 1 (IDX9022) and
SEQ ID NO: 4 (IDX9058).
29. A method according to claim 27, wherein the oligonucleotide is
SEQ ID NO: 1 (IDX9022).
30. A method for enhancing a treatment of a condition wherein CD20
expressing cells participate in the pathogenesis of said condition,
wherein an oligonucleotide selected from the group consisting of
SEQ ID NO: 7 (IDX0150) and SEQ ID NO: 8 (IDX0505), or a
pharmaceutical composition comprising said oligonucleotide, is
administered in a dose sufficient to induce an up-regulation of the
cell surface antigen CD20, and wherein said oligonucleotide is
administered before said treatment.
31. A method according to claim 27, wherein said condition is
cancer, and said oligonucleotide is administered in a dose
effective to induce an endogenous production of at least one
cytokine and an up-regulation of the expression of the cell surface
antigen CD20.
32. A method according to claim 27, wherein said condition is
multiple sclerosis.
33. A method according to claim 27, wherein the route of
administration is selected from the group consisting of
intravenous, subcutaneous, mucosal, intramuscular, and
intraperitoneal administration.
34. A method according to claim 27, wherein the route of
administration is mucosal administration selected from the group
consisting of nasal, oral, gastric, ocular, rectal, urogenital and
vaginal administration.
35. A method according to claim 27, wherein the oligonucleotide is
administered in an amount of about 1 .mu.g to about 2000 .mu.g per
kg body weight.
36. A method according to claim 27, wherein the oligonucleotide is
administered in combination with an immunotherapy, and said
oligonucleotide is administered in advance of said immunotherapy,
preferably about 6, about 12, about 24, or about 48 hours before
said therapy.
37. A method according to claim 27, wherein the oligonucleotide is
administered in combination with an immunotherapy, and said
oligonucleotide is administered in advance of said immunotherapy,
preferably about 3 days, or about 5, 7, or 14 days before said
therapy.
38. A method for increasing the therapeutic effect of a cell
surface antigen targeted therapy, wherein said target is CD20,
wherein an oligonucleotide selected from the group consisting of
SEQ ID NO: 1-6, or a pharmaceutical composition comprising said
oligonucleotide, is administered in a dose sufficient to induce an
up-regulation of the cell surface antigen CD20.
39. A method according to claim 38, wherein the oligonucleotide is
selected from the group consisting of SEQ ID NO: 1 (IDX9022) and
SEQ ID NO: 4 (IDX9058).
40. A method according to claim 38, wherein the oligonucleotide is
SEQ ID NO: 1 (IDX9022).
41. A method for increasing the therapeutic effect of a cell
surface antigen targeted therapy, wherein said target is CD20,
wherein an oligonucleotide selected from the group consisting of
SEQ ID NO: 7 (IDX0150) and SEQ ID NO: 8 (IDX0505), or a
pharmaceutical composition comprising said oligonucleotide, is
administered in a dose sufficient to induce an up-regulation of the
cell surface antigen CD20, and wherein said oligonucleotide is
administered before said treatment.
42. A method according to claim 38, wherein said condition is
cancer, and said oligonucleotide is administered in a dose
effective to induce an endogenous production of at least one
cytokine and an up-regulation of the expression of the cell surface
antigen CD20.
43. A method according to claim 38, wherein said condition is
multiple sclerosis.
44. A method according to claim 38, wherein the route of
administration is selected from the group consisting of
intravenous, subcutaneous, mucosal, intramuscular, and
intraperitoneal administration.
45. A method according to claim 38, wherein the route of
administration is mucosal administration selected from the group
consisting of nasal, oral, gastric, ocular, rectal, urogenital and
vaginal administration.
46. A method according to claim 38, wherein the oligonucleotide is
administered in an amount of about 1 .mu.g to about 2000 .mu.g per
kg body weight.
47. A method according to claim 38, wherein the oligonucleotide is
administered in combination with an immunotherapy, and said
oligonucleotide is administered in advance of said immunotherapy,
preferably about 6, about 12, about 24, or about 48 hours before
said therapy.
48. A method according to claim 38, wherein the oligonucleotide is
administered in combination with an immunotherapy, and said
oligonucleotide is administered in advance of said immunotherapy,
preferably about 3 days, or about 5, 7, or 14 days before said
therapy.
49. A method according to claim 38, said therapy is selected from
the group consisting of an immunological therapy, treatment with
antibodies, the administration of steroids, cortisone treatment,
interferon treatment, or a combination of any of these.
50. A method according to claim 38, wherein said treatment includes
the administration of an antibody.
51. A method of increasing the efficiency of an immunotherapy
directed towards a specific antigen target, wherein the method
comprises the steps of: a) collecting a sample from said patient
e.g. tissue (blood, biopsy, etc) and quantifying the expression of
the antigen of interest in said sample; b) adding one
oligonucleotide selected from the group consisting of SEQ ID NO:
1-8 to said sample; c) determining whether the expression of said
antigen can be up-regulated in the sample by the addition of said
oligonucleotide; d) administering the oligonucleotide to said
patient in an amount effective to up-regulate the expression of
said antigen; and e) administering an antibody drug to said
patient, said antibody drug being directed to the antigen of
interest.
52. The method according to claim 51, wherein said antigen of
interest is CD20.
53. The method of claim 51, wherein said disease is cancer.
54. The method of claim 51, wherein said disease is multiple
sclerosis.
Description
TECHNICAL FIELD
[0001] The present inventions concern the field of immunotherapy
and in particular the increased expression of CD20, CD23, CD69 and
CD80 and makes available methods and compounds for this use.
BACKGROUND
[0002] The use of cell surface antigens as therapeutic targets is a
growing area of interest. Immunotherapy is used in the treatment or
alleviation of many immunological diseases or conditions, such as
cancer, inflammatory diseases such as asthma, allergy etc,
including autoimmune disorders such as multiple sclerosis (MS).
Monoclonal antibodies are offering substantial advantages in terms
of potency, reproducibility and freedom from contaminants. It is in
the areas of transplantation, cancer treatment and autoimmune
disease that recent discoveries in immunology are having new
impact.
[0003] There are several options of using antibody-related
therapies. The antibody can be used to bind to a specific target
molecule on the cell surface to trigger cellular mechanisms such as
apoptosis or activation pathways (immunotherapy), or simply bind to
a target on the cell surface for delivery of an agent to the
specific cell type, e.g. a cytostatic agent (immune-chemo therapy)
which could be combined with e.g. irradiation therapy.
[0004] Antibody mediated immunotherapy has been used in bone marrow
transplantations, where antibodies are used to remove donor T-cells
and prevent graft-versus-host disease; in many types of different
cancers such as leukemia and lymphoma; as well as for the treatment
of some autoimmune diseases such as rheumatoid arthritis,
vasculitis and MS. Examples of these antibodies include anti-CD52
(for depleting lymphocytes), anti-CD25 (specific for activated
T-cells), anti-CD4 (for blocking the function of the critical
T-helper cells) and anti-CD18 (which blocks the migration of
leukocytes from the blood to sites of inflammation).
[0005] Several antibodies have recently been approved for the
treatment of cancer. The anti-CD20 antibody rituximab, which is a
genetically engineered chimeric murine/human monoclonal antibody
directed against human CD20 (Rituxan.RTM. or MabThera.RTM., from
Genentech Inc., South San Francisco, Calif., U.S.) is used for the
treatment of patients with relapsed or refractory low-grade or
follicular, CD20 positive, B-cell non-Hodgkin's lymphoma. Rituximab
works by recruiting the body's natural defences to attack and kill
the B-cell to which it binds via the CD20 antigen. In vitro
mechanism of action studies have demonstrated that rituximab binds
human complement and lyses lymphoid B-cell lines through
complement-dependent cytotoxicity (CDC) (Reff et al., 1994).
Additionally, it has significant activity in assays for
antibody-dependent cellular cytotoxicity (ADCC). In vivo
preclinical studies have shown that rituximab depletes B-cells from
the peripheral blood, lymph nodes, and bone marrow of cynomolgus
monkeys, presumably through complement and cell-mediated processes
(Reff et al., 1994). Analysis of chronic lymphocytic leukemia (CLL)
patients shows that the density of CD20 on the surface of B-CLL
cells is rather variable with some patient's B-cells expressing
very low levels of the CD20 antigen. The typical treatment for
B-cell malignancies, besides rituximab, is the administration of
radiation therapy and chemotherapeutic agents. In the case of CLL,
a combination of two or three chemotherapies is often used to
destroy malignant cells. However, side effects are a limiting
factor in this treatment.
[0006] Another monoclonal antibody used is alemtuzumab
(Campath.RTM. or MabCampath.RTM., an anti-CD52 from Ilex
Pharmaceuticals) (Keating, et al., 2002) which was approved for the
treatment of CLL in 2001. Bevacizumab (Avastin.RTM., Genentech,
Inc., South San Francisco, Calif.) is a humanized IgG1 mAb directed
against vascular endothelial growth factor (VEGF) used in treatment
of colorectal cancer, small cell lung cancer and breast cancer.
Trastuzumab (Herceptin.RTM. from Roche) is a humanized IgG1 mAb
that is effective against metastatic breast cancer tumours
over-expressing the HER-2 target (Strome et al., 2007).
[0007] Molecular engineering has improved the prospects for
antibody-based therapeutics, resulting in different constructs and
the development of humanized or human antibodies that can be
frequently administered.
[0008] Another widely used treatment for haematological
malignancies is chemotherapy. Combination chemotherapy has some
success in reaching partial or complete remissions. Unfortunately,
the remissions obtained through chemotherapy are often not
durable.
[0009] Currently, a number of other monoclonal antibodies are being
investigated for MS, including some that are already in use in
other conditions. These include ocrelizumab (Genetech/Hoffmann-La
Roche), daclizumab (Biogen Idec, Inc.), alemtuzumab (Campath.RTM.,
MabCampath.RTM., Bayer Schering, BTG, Genzyme, Millenium) and
rituximab (Rituxan.RTM., MabThera.RTM., Genentech, Hoffmann-La
Roche, Biogen Idec Inc.) In 2004, the FDA approved the use of a
monoclonal antibody (Natalizumab, Tysabri.RTM., Biogen Idec Inc.,
Cambridge, Massacheusetts, USA, and Elan Pharmaceuticals, Inc.,
Dublin, Ireland) for the treatment of patients with relapsing forms
of MS (FDA News PO4-107, Nov. 23, 2004). While generally well
tolerated, natalizumab is occasionally associated with severe
adverse effects.
[0010] Antibody therapy in general is costly, and there is a need
for improvements inter alia with regards to efficacy.
[0011] Synthetic CpG oligonucleotides, CpG-ODNs, are a new class of
immuno-modulatory agents that stimulate the immune system. Recent
studies demonstrate that at least three classes of CpG-ODN
sequences exist, each with different physical characteristics and
biological effects. Preliminary studies in several animal models of
cancer suggest that CpG-ODNs may have many uses in cancer
immunotherapy. CpG-ODNs have the ability to induce tumour
regression by activating innate immunity, and serving as potent
vaccine adjuvants that elicit a specific, protective immune
response. Early clinical trials indicate that CpG-ODNs can be
administered safely to humans, and studies are ongoing to
understand how these agents may play a role in cancer immunotherapy
(Wooldridge, J E, et al. 2003). There are indications that the CpG
motif alone is not accountable for the efficacy of the
CpG-oligonucleotides. There are even indications that this motif is
not necessary for the desired function, but that the backbone
structure also is of importance for their immunomodulatory
effects.
[0012] Immunotherapy of cancer has been explored for over a
century, but it is only in the last decade that various
antibody-based products have been introduced into the management of
patients with diverse forms of cancer. At present, this is one of
the most active areas of clinical research, with eight therapeutic
products already approved in oncology. Antibodies against
tumour-associated markers have been a part of medical practice in
immunohistology and in vitro immunoassays for several decades, and
are now becoming increasingly recognized as important biological
agents for the detection and treatment of cancer (Strome et al.,
2007).
[0013] CD20 is variably expressed on the surface of B-cells in CLL
patients, with some patients' B-cells expressing very low levels of
the CD20 antigen. CD20 (human B-lymphocyte restricted
differentiation antigen), is a hydrophobic transmembrane protein
with a molecular weight of approximately 35 kD located on pre-B and
mature B lymphocytes. The antigen is also expressed on more than
90% of B-cells in non Hodgkin's lymphomas (NHL), but is not found
on hematopoietic stem cells, pro B-cells, normal plasma cells or
other normal tissues. CD20 regulates an early step(s) in the
activation process for cell cycle initiation and differentiation,
and possibly functions as a calcium ion channel. CD20 is not shed
from the cell surface and does not internalize upon antibody
binding. Free CD20 antigen is not found in the circulation
(Pescovitz, 2006).
[0014] The expression of CD23 is highly up-regulated in normal
activated follicular B-cells and has been found to be consistently
present at higher levels in B-CLL cells. The CD23 leukocyte
differentiation antigen is a 45 kD type II transmembrane
glycoprotein expressed on several haematopoietic lineage cells,
which function as a low affinity receptor for IgE (Fc.gamma.RII)
(Pathan et al., 2008). It is a member of the C-type lectin family
and contains an .alpha.-helical coiled-coil stalk between the
extracellular lectin binding domain and the transmembrane region.
The stalk structure is believed to contribute to the
oligomerization of membrane-bound CD23 to a trimer during binding
to its ligand (for example, IgE). Upon proteolysis, the membrane
bound CD23 gives rise to several soluble CD23 (sCD23) molecular
weight species (37 kD, 29 kD and 16 kD). In addition to being
involved in regulating the production of IgE, CD23 has also been
speculated to promote survival of germinal center B-cells.
Lumiliximab is a monoclonal chimeric anti-CD23 antibody (Biogen
Idec, San Diego, USA) that harbours macaque variable regions and
human constant regions (IgG1, K) and was originally developed to
inhibit the production of IgE by activated human blood B-cells. It
is currently undergoing two Phase II trials for use in B-CLL
patients. In vitro studies have shown that lumiliximab induces
caspase dependent apoptosis in B-CLL cells through the
mitochondrial death pathway (Pathan et al., 2008). Thus, it seems
to induce apoptosis of tumour cells through a mechanism different
from rituximab.
[0015] The protein CD80 is a molecule found on activated B-cells,
macrophages/monocytes and dendritic cells which provides a
co-stimulatory signal necessary for T-cell activation and survival.
It is also known as B7.1. Contact between B and T-cells can be
mediated by antigen presentation, as well as antigen-independent
cell interaction by adhesion molecules and co-stimulatory molecules
(CD80, CD86, CD40). Its principal mode of action is by binding to
CD28. Along with CD86, these molecules provide the necessary
stimuli to prime T-cells against antigens presented by
antigen-presenting cells. CD80 and CD86 also bind to CTLA-4, a cell
surface molecule expressed on activated T-cells. Interactions
between CD80 or CD86 with CTLA-4 decrease the response of
T-cells.
[0016] The anti-CD80 monoclonal antibody galiximab (Biogen Idec)
has been studied as a single-agent in previously treated follicular
lymphoma (FL) and in combination with the anti-CD20 antibody
rituximab against relapsed FL. In addition to B-cells,
macrophages/monocytes and dendritic cells, the CD80 molecule is
also found on the surface of activated macrophages, dendritic cells
and cells from various subtypes of non Hodgkin's lymphoma (NHL).
Galiximab's potential mechanisms of action include ADCC and
possible immunomodulatory effects on host effector cells affecting
the tumor microenvironment. Galiximab seems to induce apoptosis of
tumor cells through mechanisms similar to rituximab. Thus, there is
good reason to believe that an upregulation of CD80 surface
expression enhance galiximab-induced apoptosis of cancer cells.
[0017] CD69 is a type II integral membrane protein with a single
transmembrane domain belonging to the C-type lectin family of
surface receptors with a molecular weight of 60 kDa. CD69 is a
leukocyte receptor transiently induced after activation and is
detected on NK-cells and small subsets of T and B-cells in
peripheral lymphoid tissues from healthy subjects.
[0018] Multiple sclerosis (MS) is an autoimmune disease that
affects the central nervous system, i.e. the brain and spinal cord.
Inflammation destroys the myelin, leaving multiple areas of scar
tissue (sclerosis) and the nerve impulses are slowed down or
blocked. The inflammation occurs when the body's own immune cells
attack the nervous system.
[0019] Therapy with antibodies (and other biological molecules) is
limited by the ability of the patient's immune system to detect the
new substance and neutralise it. Some cells express too little
antigen to be targeted and cells in a large mass may escape
attention altogether. One novel aspect of immuno-therapies is that
they are based on the natural molecules which normally operate in
concert to modulate and control the immune system.
[0020] Another problem is if a patient has a low endogenous
expression of a certain receptor, i.e. the target molecule for the
immunotherapy. There are also patients that become resistant during
a therapy or where the receptors do not respond as in the beginning
of the therapy.
[0021] Molecular engineering has improved the prospects for such
antibody-based therapeutics, resulting in different constructs and
humanized or human antibodies that can be administered more
frequently.
[0022] The success of antibody treatment also varies depending on
the availability of safe antibodies for the patient, the efficiency
such as the number of binding sites on the target cell, and also
the time of treatment. Apart from technical circumstances, the
therapy is quite expensive. By using CpG ODNs, i.e.
immunostimulatory oligonucleotides, to improve the responsiveness
(e.g. induce/decrease cell surface molecules on the target cell) to
immunotherapy of a patient, the immunotherapy could become more
efficient and therefore also less expensive.
[0023] WO 01/97843 disclose a method for treating cancer by
administrating to the subject an immunostimulatory nucleic acid and
an antibody specific for the cell surface marker induced on the B
cell in order to treat the cancer.
[0024] Regardless of the considerable effort spent on developing
oligonucleotide based therapeutic approaches to cancer and
inflammatory diseases etc, and the occasional success reported so
far, there still remains a need for identifying new, more specific,
functional and safe compounds and modes of administration,
exhibiting improved efficacy and minimal or no side effects.
SUMMARY
[0025] The present invention makes available a method for the
regulation of certain cell surface antigens for increasing the
efficiency of therapies related to cell surface antigens, such as
immunotherapy for the prevention, treatment and/or alleviation of
B-cell associated indications, such as cancer, inflammatory
diseases and autoimmune diseases, such as MS.
[0026] The inventors surprisingly found that specific
oligonucleotide sequences were capable of up-regulating the
expression of certain cell surface molecules or cell surface
antigens, in particular cell surface antigens, such as CD20, CD23,
CD69 and CD80.
[0027] The use of immune modulators such as ODNs to increase the
expression of certain cell surface antigens, could increase the
efficiency of treatments that target the cell surface antigens,
either alone or in different combinations. In particular, the
inventors showed that the prior incubation with an oligonucleotide
sequence according to the invention significantly increased the
rate of apoptosis mediated by a monoclonal antibody (rituximab)
administered to human B-cells. The inventors therefore make
available a method for increasing the efficiency of treatments of
various diseases (cancers, inflammatory diseases and autoimmune
disorders) using a monoclonal antibody wherein the patient is
preconditioned before the administration of said antibody, wherein
the preconditioning comprises the administration of an
oligonucleotide according to the invention. Other problems
underlying the invention, as well as advantages associated with the
invention, will become evident to the skilled person upon study of
the description, examples, and claims, incorporated herein by
reference.
SHORT DESCRIPTION OF THE DRAWINGS
[0028] The invention will be described in closer detail in the
following description, non-limiting examples and claims, with
reference to the attached drawings in which
[0029] FIG. 1 consists of seven graphs (1a-1g) wherein FIG. 1a-d
shows that treatment of CLL-cells with IDX-compounds increased the
number of CD19+ cells expressing CD20, CD23, CD69 and CD80, as well
as activation of NK cells. These effects are important steps in
enhancing rituximab-induced ADCC of malignant B-CLL cells. FIG.
1e-g shows the cytokine profiles of IDX-compounds in PBMCs derived
from CLL-blood.
[0030] FIG. 1a shows the effect of the test compounds on the
expression of CD20 in peripheral blood mononuclear cells (PBMCs)
from CLL patients. CLL-PBMCs were treated with medium only
(untreated) or 1, 10 or 25 .mu.M of IDX-compounds for 48 hrs and
the surface expression of CD20 was subsequently analyzed by flow
cytometry. Columns represent means of the mean fluorescence
intensity (MFI) and standard deviations of CD19+/CD20+ cells from
18 patient samples.
[0031] FIG. 1b is a graph showing the effect of IDX-compounds on
the expression of CD23 in malignant B-CLL cells. PBMCs isolated
from fresh B-CLL blood were treated with medium only (untreated) or
1, 10 or 25 .mu.M of IDX-compounds for 48 hrs and the surface
expression of CD23 was subsequently analyzed by flow cytometry.
Columns represent means of the MFI and standard deviations of
CD19+/CD23+ cells from 18 patient samples.
[0032] FIG. 1c shows the effect of IDX-compounds on the expression
of CD80 in malignant B-CLL cells. PBMCs isolated from fresh B-CLL
blood were treated with medium only (untreated) or 1, 10 or 25
.mu.M of IDX-compounds for 48 hrs and the surface expression of
CD80 was subsequently analyzed by flow cytometry. Columns represent
means of the MFI and standard deviations of CD80 on CD19+ cells
from 18 B-CLL patient samples.
[0033] FIG. 1d shows the effect of IDX-compounds (1, 10 or 25
.mu.M, or medium only, for 48 hrs) on the activation of NK-cells
(CD3-/CD56+) in PBMCs from B-CLL cells and the surface expression
of CD69 was subsequently analyzed by flow cytometry. Columns
represent means of the percentages and standard deviations of
CD3-/CD56+/CD69+ cells from 18 patient samples.
[0034] FIG. 1e shows human CLL-PBMCs treated with IDX-compounds for
48 hrs after which the expression of IL-6 was analyzed using the
cytometric bead array (CBA) Flex kit (BD Biosciences, New Jersey,
USA). Columns represent means of the expression in pg/ml and
standard deviations in cells from 6 patient samples.
[0035] FIG. 1f shows the cytokine profiles of IDX-compounds in
PBMCs derived from CLL-blood. Human CLL-PBMCs were treated with
IDX-compounds for 48 hrs and the expression of IL-10 was measured
by CBA analysis. Columns represent means of the expression in pg/ml
and standard deviations in cells from 5 patient samples.
[0036] FIG. 1g shows the cytokine profiles of IDX-compounds in
PBMCs derived from CLL-blood. Human CLL-PBMCs were treated with
IDX-compounds for 48 hrs and the expression of IP-10 was measured
by CBA analysis. Columns represent means of the expression in pg/ml
and standard deviations in PBMC isolations from 4 patients.
[0037] FIG. 2 is a graph showing the increased CD20 expression on B
cells in PBMCs isolated from MS patients (RRMS). The PBMCs were
incubated for 48 hrs with 1, 10 or 25 .mu.M of IDX9022. Cells were
the harvested and analyzed for CD20 expression using FACS analysis.
Columns represent means of MFI and standard deviations of
CD19+/CD20+ cells from 4 patient samples.
[0038] FIG. 3 consists of six graphs showing that pretreatment of
CLL-PBMCs with IDX-compounds enhances rituximab-mediated ADCC. In
all diagrams, columns represent means of the percentages and
standard deviations of apoptotic CD19+ cells.
[0039] FIG. 3a shows a graph where purified PBMCs from fresh CLL
blood (n=20) were stimulated in vitro for 48 hrs with IDX9022 to
increase CD19+/CD20+ levels, after which rituximab was added at 5
or 10 .mu.g/ml. ADCC was measured by FACS analysis 24 hrs later,
measuring the levels of Annexin V/7-AAD double positive CD19+
cells. The results are compared to those of untreated cells and
cells treated with 1 and 10 .mu.M of IDX9022 only. n=18.
[0040] FIG. 3b shows a graph where pre-treatment of CLL-PBMCs with
rituximab before treatment with IDX9022 does not enhance
rituximab-induced ADCC. Purified CLL-PBMCs were treated with
rituximab at 5 or 10 .mu.g/ml for 48 hrs and subsequently treated
with 1 or 10 .mu.M of IDX9022 for another 24 hrs. ADCC was analyzed
as in FIG. 3a. n=10.
[0041] FIG. 3c shows a graph where PBMCs purified from fresh CLL
blood were stimulated in vitro for 48 hrs with IDX9022 or IDX0150
to increase CD19+/CD20+ levels, after which rituximab was added at
5 or 10 .mu.g/ml. ADCC was measured by FACS analysis 24 hrs later,
measuring the levels of Annexin V/7-AAD double positive CD19+
cells. The results are compared to those of untreated cells and
cells treated with IDXs only. n=10.
[0042] FIG. 3d shows a graph where PBMCs purified from fresh CLL
blood were stimulated in vitro for 48 hrs with IDX9022 or IDX0505,
respectively, to increase CD19+/CD20+ levels, after which rituximab
was added at 5 or 10 .mu.g/ml. ADCC was measured by FACS analysis
24 hrs later, measuring the levels of Annexin V/7-AAD double
positive CD19+ cells. The results are compared to those of
untreated cells and cells treated with 1 and 10 .mu.M of the IDXs
only. n=10.
[0043] FIG. 3e shows a graph where PBMCs purified from fresh CLL
blood were stimulated in vitro for 48 hrs with IDX9022 or IDX9058
to increase CD19+/CD20+ levels, after which rituximab was added at
5 or 10 .mu.g/ml. ADCC was measured by FACS analysis 24 hrs later,
measuring the levels of Annexin V/7-AAD double positive CD19+
cells. The results are compared to those of untreated cells and
cells treated with IDX-compounds only. n=10.
[0044] FIG. 3f shows a graph where pre-treatment of CLL-PBMCs with
IDX0011 does not enhance rituximab-induced ADCC. PBMCs purified
from fresh CLL blood were stimulated in vitro for 48 hrs with
IDX9022 or IDX0011 to increase CD19+/CD20+ levels, after which
rituximab was added at 5 or 10 .mu.g/ml. ADCC was measured by FACS
analysis 24 hrs later, measuring the levels of Annexin V/7-AAD
double positive CD19+ cells. The results are compared to those of
untreated cells and cells treated with IDX-compounds only. n=4.
[0045] FIG. 4 consists of three graphs (a-c) showing the expression
of CD20, CD23 and CD80, respectively, on CD19+ cells after pulsed
treatment with IDX-compounds IDX9022 (SEQ ID NO 1, Table 1) and
IDX0150 (SEQ ID NO 7, Table 1).
[0046] FIG. 4a shows the results of CD20 expression on human CLL
B-cells after varying time periods of treatment with IDX-compounds.
PBMCs from four patients diagnosed with CLL were stimulated with
0.1, 1, 10 or 25 .mu.M of IDX0150 and IDX9022 for 2, 6 or 24 hrs.
Thereafter, cells were washed (w) to remove free IDX-compounds and
the cells were incubated further for a total of 72 hrs. Some cells
were incubated with IDX-compounds during the whole incubation
period, i.e. 72 hrs, or with medium alone (untreated). Cells were
subsequently harvested and analyzed for CD20 expression by flow
cytometry. The mean percentages and standard deviations of CD20
positive cells out of CD19 positive cells are shown.
[0047] FIG. 4b is a graph showing the results of CD23 expression on
CLL B-cells after varying time periods of treatment with
IDX-compounds. PBMCs from one CLL patient were treated with
IDX-compounds as in FIG. 4a. Cells were subsequently harvested and
analyzed for CD23 surface expression by flow cytometry. The MFI of
CD23 positive B-cells is shown.
[0048] FIG. 4c shows the results of CD80 expression in CLL B-cells
after varying time periods of treatment with IDX-compounds. PBMCs
from one CLL patient were stimulated with IDX-compounds as in FIG.
4a. Cells were subsequently harvested and analyzed for CD80 surface
expression by flow cytometry. The MFI of CD80 positive B-cells is
shown.
DESCRIPTION
[0049] The following description is of the best mode presently
contemplated for carrying out the invention. This description is
not to be taken in a limiting sense, but is made solely for the
purpose of describing the general principles of the invention. The
scope of the invention should be determined with reference to the
claims.
[0050] Before the invention is described in detail, it is to be
understood that this invention is not limited to the particular
compounds described or process steps of the methods described as
such compounds and methods may vary. It is also to be understood
that the terminology used herein is for purposes of describing
particular embodiments only, and is not intended to be limiting. It
must be noted that, as used in the specification and the appended
claims, the singular forms "a," "an" and "the" include plural
referents unless the context clearly dictates otherwise. Thus, for
example, reference to "a sequence" includes more than one such
sequence, and the like.
[0051] Further, the term "about" is used to indicate a deviation of
+/-2% of the given value, preferably +/-5% and most preferably
+/-10% of the numeric values, when applicable.
[0052] For purposes of the invention, the term "immunomodulatory
oligonucleotide" refers to an oligonucleotide as described above
that induces an immune response either stimulating the immune
system or repressing the immune system or both in an organism when
administered to a vertebrate, such as a mammal.
[0053] The term "immunomodulatory response" describes the change of
an immune response when challenged with an immunomodulatory
oligonucleotide. This change is measurable often through the
release of certain cytokines such as interleukins as well as other
physiological parameters such as proliferation. The response can
equally be one that serves to stimulate the immune system, as well
as to repress the immune system depending on the cytokines induced
by the immunomodulatory oligonucleotide in question.
[0054] The phrase "therapeutically effective amount" is used herein
to mean an amount sufficient to induce the expression of said cell
surface antigen in an amount that enhance the immunotherapy or
enhance a response to other medicaments such as, steroids or other
anti-inflammatory agents to some beneficial degree.
[0055] The term "diseases" includes but is not limited to: cancers,
e.g. B-cell malignancies, lymphomas, leukemias, and conditions or
diseases wherein suppression of B-cell immune function is
therapeutically beneficial, e.g. autoimmune diseases (e.g. MS,
thrombocytopenia, lupus or rheumatoid arthritis), allergic diseases
and transplant rejections.
[0056] The invention finds utility in the treatment of cancer and
MS, as supported by the in vitro data presented in the experimental
section and illustrated in the attached figures.
[0057] An inflammatory disease is in this context defined as a
disease characterized by inflammation. Examples include, but are
not limited to, allergic conditions, asthma, allergic rhinitis,
inflammatory bowel disease (Crohn's disease and related
conditions), multiple sclerosis, chronic obstructive pulmonary
disease (COPD), rheumatoid arthritis and cardiovascular diseases
with an inflammatory component.
[0058] The term "inflammation" can be defined as an immunologic
response to injury or irritation, characterized by local
mobilization of white blood cells and antibodies, swelling and
fluid accumulation. This is a response that is identical whether
the injurious agent is a pathogenic organism, foreign body,
ischemia, physical trauma, ionizing radiation, electrical energy or
extremes of temperature. Although a defence and repair mechanism of
the body, the reactions produced during inflammation may be harmful
and develop into e.g. chronic inflammation, hypersensitivity
reactions, systemic or local inflammatory diseases.
[0059] In order to make antibody drugs more efficient, an
up-regulation of the specific antigen targets on the surface of the
target cells. i.e., tumour cells might be helpful. One way of
obtaining such an effect could be to stimulate the cells with
immunomodulatory oligonucleotides. Immune stimulatory effects can
be obtained through the use of synthetic DNA-based
oligodeoxynucleotides (ODN). Such ODN have highly immunostimulatory
effects on human and murine leukocytes, inducing B-cell
proliferation; cytokine and immunoglobulin secretion; natural
killer (NK) cell lytic activity and IFN-gamma secretion; and
activation of dendritic cells (DCs) and other antigen presenting
cells to express co-stimulatory molecules and secrete cytokines,
especially the Th1-like cytokines that are important in promoting
the development of Th1-like T-cell responses (Krieg et al, 1995).
The increase in receptor density by ODNs could be mediated through
a direct effect of the oligonucleotides on the cells, or through
the induction of cytokines. An increase in antigen density or an
increase in the population of cells expressing the target receptors
would enable the antibodies to kill the tumour cells more
efficiently, either through enhancing antibody-dependent cellular
cytotoxicity (ADCC) or complement-dependent cytotoxicity (CDC).
[0060] The invention makes available novel oligonucleotide
sequences according to any one of SEQ ID NO. 1-6 (see Table 1)
capable of at least one of the following: induction of the
expression of endogenous cytokines, such as but not limited to the
interleukins IL-6 and IL-10, and/or up-regulation of the expression
of specific cell surface antigens.
[0061] The invention also makes available the manufacture of a
pharmaceutical composition comprising one of the oligonucleotides
according to SEQ ID NO. 1-8, for the treatment or enhancement of
the treatment comprising of up-regulation of the expression of a
cell surface antigen, in order to treat or enhance a treatment of a
condition wherein the antigen expressing cells participate in the
pathogenesis of said condition.
TABLE-US-00001 TABLE 1 Examples of oligonucleotide sequences SEQ ID
NO. IDX-No Seq 5'-3' 1 IDX9022 T*C*G*TCGTTCTGCCATCGTC*G*T*T 2
IDX9038 T*C*G*TCGTTCGGCCGATCG*T*C*C 3 IDX9052 G*G*G*GTCGTCTG*C*G*G
4 IDX9058 G*A*T*CGTCCGTCGG*G*G*G 5 IDX9071
T*C*G*TTCGTCTGCTTGTTC*G*T*C 6 IDX0011
C*C*G*GGGTCGCAGCTGAGCCCA*C*G*G 7 IDX0150 G*G*A*ACAGTTCGTCCAT*G*G*C
8 IDX0505 G*G*A*A*C*A*G*T*T*G*C*T*C*C*A*T*G*G*C *= phosphorothioate
modification
[0062] The above sequences SEQ ID NO. 1-6 have been designed by the
inventors, and are to the best knowledge of the inventors, not
previously known.
[0063] SEQ ID NO. 7 (IDX0150) is known from U.S. Pat. No.
6,498,147, and currently undergoing clinical trials for the
treatment of inflammatory bowel disease (Kappaproct.RTM., Index
Pharmaceutical AB, Solna, Sweden).
[0064] SEQ ID NO. 8 (IDX0505) is known from WO 2007/004977 and WO
2007/004979 (as IDX0526) and corresponds to SEQ ID NO. 7 (IDX0150)
but comprises a GC motif instead of a CG motif.
[0065] SEQ ID NO. 7, although known for medical use, is to the best
knowledge of the inventors not previously known for use in the
induction of cell surface antigens.
[0066] SEQ ID NO. 8, although known for medical use, is to the best
knowledge of the inventors not previously known for use in the
induction of cell surface antigens.
[0067] The inventors have surprisingly shown that specific
oligonucleotides are capable of eliciting or increasing the
expression of specific cell surface markers, here exemplified by
CD20, CD23, CD69 and CD80.
[0068] Consequently, the present inventors make available an
isolated and substantially purified oligonucleotide chosen among
SEQ ID NO. 1-6.
[0069] According to one embodiment, at least one nucleotide in such
oligonucleotides has a phosphate backbone modification. Preferably
said phosphate backbone modification is a phosphorothioate or
phosphorodithioate modification.
[0070] The inventors also make available pharmaceutical
compositions comprising an oligonucleotide according to any one of
SEQ ID NO. 1-6. Said pharmaceutical compositions further preferably
comprise a pharmacologically compatible and physiologically
acceptable excipient or carrier, chosen from saline, liposomes,
surfactants, mucoadhesive compounds, enzyme inhibitors, bile salts,
absorption enhancers, cyclodextrins, or a combination thereof.
[0071] The invention finds utility in treatments or in the
enhancement of treatments wherein the oligonucleotides are used as
a tool for up-regulating a specific cell surface antigen on a
specific cell type and in which specific antibodies are
administered to bind to the up-regulated cell surface antigens for
the purpose of eliminating a specific cell type.
[0072] Another embodiment of the invention is thus the use of an
isolated and substantially purified oligonucleotide according to
any one of SEQ ID NO. 1-6, and 7-8 for the manufacture of a
pharmaceutical composition for the treatment, and/or enhancement of
antibody based therapies.
[0073] Yet another embodiment of the invention is the use of an
isolated and substantially purified oligonucleotide according to
any one of SEQ ID NO. 1-8, and 7-8 for the manufacture of a
pharmaceutical composition for up-regulation of the expression of a
cell surface antigen, chosen between CD20, CD23, CD69 and CD80, in
order to treat or enhance a treatment of a condition wherein the
antigen expressing cells participate in the pathogenesis of said
condition. Preferably the antigen is CD20.
[0074] Another embodiment is a pharmaceutical composition
comprising one of the oligonucleotides according to SEQ ID NO. 1
[IDX9022] or SEQ ID NO. 4 [IDX9058], preferably SEQ ID NO. 1
[IDX9022].
[0075] Another embodiment is the use of an isolated and
substantially purified oligonucleotide according to SEQ ID NO. 1,
SEQ ID NO. 4, SEQ ID NO. 7 for the manufacture of a pharmaceutical
composition for the up-regulation of cell surface antigens, wherein
the antigens are chosen from but not limited to CD20, CD69 or
CD80.
[0076] Another embodiment is the use of an isolated and
substantially purified oligonucleotide according to SEQ ID NO. 1,
SEQ ID NO. 2, SEQ ID NO.5 or SEQ ID NO.7 for the manufacture of a
pharmaceutical composition for the up-regulation of cell surface
antigens, wherein the antigens are chosen from but not limited to
CD23.
[0077] One embodiment is the use of an isolated and substantially
purified oligonucleotide according to SEQ ID NO. 7 [IDX0150] or SEQ
ID NO. 8 [IDX0505], for the manufacture of a pharmaceutical
composition for up-regulation of the expression of the cell surface
antigen CD20 in order to treat or enhance a treatment of a
condition wherein CD20 expressing cells participate in the
pathogenesis of said condition.
[0078] Yet another embodiment of the invention is the use of an
isolated and substantially purified oligonucleotide for the
manufacture of the above mentioned pharmaceutical composition,
wherein the oligonucleotide according to SEQ ID NO. 1-8, is
administered in an amount effective to induce the endogenous
production of at least one cytokine, and the up-regulation of the
expression of one of the chosen cell surface antigens, preferably
the antigen is CD20.
[0079] The inventors therefore make available, as one embodiment of
the invention, compounds and methods for the treatment of said
diseases wherein the inventive compounds presented in Table 1 are
used either alone; to increase the expression of endogenous
cytokines, such as the interleukins IL-6 and IL-10, but not limited
to these, or to up-regulate the expression of one or more of the
cell surface antigens CD20, CD23, CD69 and CD80; or in combination
with an anti-cancer therapy, anti-MS therapy or other treatments,
preferably an immunological treatment comprising the administration
of an antibody to the patient.
[0080] Another embodiment is the use of an isolated and
substantially purified oligonucleotide according to SEQ ID NO. 1,
for the manufacture of a pharmaceutical composition for the
up-regulation of cell surface antigens, wherein the antigens are
chosen from but not limited to CD20, CD80 and/or CD69.
[0081] Without wishing to be bound to any specific theory, the
inventors contemplate that the effect of the inventive compounds at
least in part is accountable to their capability to induce
endogenous production of cytokines. Consequently, one embodiment of
the invention involves the administration of an oligonucleotide
according to SEQ ID NO.1-8 in an amount effective to induce
endogenous production of cytokines, such as but not limited to IL-6
and/or IL-10.
[0082] The invention also make available a method for the
treatment, and/or enhancement of a condition wherein CD20
expressing cells participate in the pathogenesis of said condition,
and/or enhancement of said treatment, wherein one of the described
oligonucleotides according to SEQ ID NO. 1-8 is administered in a
dose sufficient to induce the up-regulation of the cell surface
antigen CD20.
[0083] The inventive compounds SEQ ID NO. 1-6, and 7-8, presented
in Table 1, offer a possibility to increase the efficiency of
antibody based treatments to different diseases such as cancers,
inflammatory and autoimmune disorders, either alone, or preferably
in the form of a preconditioning before the administration of
another treatment, e.g. the administration of a monoclonal
antibody.
[0084] The diseases are chosen from but not limited to: cancer;
(e.g. B-cell malignancies, lymphomas or leukemias) and conditions
or diseases wherein suppression of B-cell immune function is
therapeutically beneficial, e.g. autoimmune diseases (e.g. MS,
thrombocytopenia, lupus or rheumatoid arthritis) allergic diseases,
transplant rejection (and indications where other therapeutic
regimens involving administration of antigenic moieties, e.g.,
gene, protein or cell therapy, are used.)
[0085] In one embodiment, the condition to be treated is cancer,
and one of the above described oligonucleotides, chosen between SEQ
ID NO. 1-6, and 7-8 is administered in a dose effective to induce
the endogenous production of at least one cytokine and the
up-regulation of the expression of the cell surface antigen
CD20.
[0086] In yet another embodiment, the condition to be treated is
multiple sclerosis, and one of the above described
oligonucleotides, chosen between SEQ ID NO. 1-6, and 7-8 is
administered in a dose effective to induce the endogenous
production of at least one cytokine and the up-regulation of the
expression of the cell surface antigen CD20.
[0087] The oligonucleotides according to the invention can be
delivered subcutaneously or topically on a mucous membrane. The
term "topically on a mucous membrane" includes oral, gastric,
pulmonary, rectal, vaginal, and nasal administration. It is well
known that the accessibility and vascular structure of the nose
make nasal drug delivery an attractive method for delivering both
small molecule drugs and biologics, systemically as well as across
the blood-brain barrier to the CNS. The nucleotides can be
delivered in any suitable formulation, such as suitable aqueous
buffers, e.g. but not limited to phosphate buffered saline (PBS).
It is contemplated that the nucleotides are administered in a
suitable formulation, designed to increase adhesion to the mucous
membrane, such as suitable gel-forming polymers, e.g. chitosan etc;
a formulation enhancing the cell uptake of the nucleotides, such as
a lipophilic delivery vehicle, liposomes or micelles; or both.
[0088] Preferably the route of administration of said medicament is
chosen from intravenous, subcutaneous, mucosal, intramuscular, and
intraperitoneal administration. The mucosal administration is
chosen from nasal, oral, gastric, ocular, rectal, urogenital and
vaginal administration.
[0089] The oligonucleotide is administered in a single dose or in
repeated doses. The currently most preferred embodiment entails one
single dose of the nucleotide according to the invention,
administered i.v., or s.c., or to a mucous membrane, e.g. given
intranasally, orally, rectally or intravaginally.
[0090] According an embodiment, the oligonucleotide is administered
by intravenous injection or infusion.
[0091] According to another embodiment the oligonucleotide is
administered subcutaneously to a patient in need thereof.
[0092] The oligonucleotide is administered in a therapeutically
effective dose. The definition of a "therapeutically effective
dose" is dependent on the disease and treatment setting, a
"therapeutically effective dose" being a dose which alone or in
combination with other treatments results in a measurable
improvement of the patient's condition.
[0093] The phrase "therapeutically effective amount" or
"therapeutically effective dose" is used herein to mean an amount
sufficient to enhance a response to a treatment.
[0094] According to one embodiment the oligonucleotide is
administered in an amount of about 1 .mu.g to about 2000 .mu.g per
kg body weight. Preferably the oligonucleotide is administered in
an amount of about 10 .mu.g to about 1000 .mu.g per kg body weight.
Most preferably, the oligonucleotide is administered in an amount
of about 20 .mu.g to about 600 .mu.g per kg body weight.
[0095] According to another embodiment, the invention is used as a
pre-treatment before an antibody-based treatment of a B-cell
related disease wherein a pharmaceutical composition is
administered to a patient.
[0096] One embodiment of the invention is to supply a
pharmaceutical composition capable of increasing the therapeutic
effect of a cell surface antigen targeted therapy, wherein said CD
target(s) is chosen among but not limited to CD20, CD23, CD69 and
CD80, preferably CD20.
[0097] One embodiment of the above described method entails
increasing the therapeutic effect of a cell surface antigen
targeted therapy, wherein said target is CD20, and wherein an
oligonucleotide according to one SEQ ID NO. 1-8, is administered in
a dose sufficient to induce the up-regulation of the cell surface
antigen CD20.
[0098] One embodiment of the described method is to administer the
oligonucleotide before, or essentially simultaneously with a
treatment.
[0099] In one embodiment said treatment includes the administration
of an antibody, preferably a CD20-antibody.
[0100] One embodiment of the invention is to pre-examine a
patient's expression of certain cell surface antigens, as well as
the response to said nucleotides and by that "predicting" the
efficiency of a treatment and also be able to improve the treatment
by giving the patient a composition as described above.
[0101] One embodiment of the invention is therefore a method of
increasing the efficiency of an immunotherapy directed towards a
specific antigen target, wherein the method comprises the steps of:
[0102] a) collection of a sample from said patient, i.e. tissue
(blood, biopsy, etc) and quantification of the expression of the
antigen of interest in said sample. [0103] b) addition of one
oligonucleotide chosen from SEQ ID NO. 1-8 in Table 1, to said
sample. [0104] c) determination whether or not the expression of
the antigen can be up-regulated in the sample by the addition of
said oligonucleotide; [0105] d) depending on the outcome of step
c), administration of said oligonucleotide to said patient in an
amount effective to up-regulate the expression of CD20, CD23, CD69
and/or CD80, preferably CD20. [0106] e) administration of an
antibody drug to said patient, wherein said antibody drug is
directed to the antigen of interest.
[0107] Preferably said antibody is an antibody directed to CD20
[0108] According to an embodiment, the above described method is
used to increase the efficiency of an immunotherapy directed
towards a specific antigen target, wherein the disease is cancer or
multiple sclerosis.
[0109] The phrase "cell surface antigen", "target" or "receptor" is
an antigen expressed on the surface of a target cell or B-cell,
which can be targeted with an antagonist which binds thereto.
[0110] The target cells are preferably B-cells but are not limited
thereto.
[0111] Examples of cell surface antigens include but are not
limited to; CD20, CD23, CD69 or CD80.
[0112] It is an embodiment of the invention to provide novel
methods for increasing the level of CDs preferably before the
administration of a CD-antibody.
[0113] Another embodiment is the up-regulation of cell surface
antigens, e.g. CD20, CD23, CD69 and/or CD80, as a pre-conditioning
or adjunct therapy. It is contemplated that the up-regulation of
specific cell surface antigens would increase the efficacy of
antibodies directed towards these antigens, such as rituximab
(anti-CD20), lumiliximab (anti-CD23) and galiximab (anti-CD80).
[0114] Examples of presently available, or under evaluation,
antibodies include, but are not limited to, rituximab
(Rituxan.RTM., MabThera.RTM.), ocrelizumab, veltuzumab, ofatumumab,
tositumomab, ibritumomab, lumiliximab, alemtuzumab (Campath.RTM.,
MabCampath.RTM.), galiximab, epratuzimab, bevacizumab
(Avastin.RTM.), and trastuzumab (Herceptin.RTM.).
[0115] The treatment is preferably an immunological therapy
involving the administration of an antibody to the patient.
Examples of antibodies include antibodies currently in use as well
as under evaluation, e.g. rituximab, ocrelizumab, altuzumab,
ofatumumab, tositumomab, ibritumomab (all directed to CD20),
lumiliximab (anti-CD23), alemtuzumab (anti-CD52), galiximab
(anti-CD80), epratuzimab (anti-CD22), and daclizumab
(anti-CD25).
[0116] In a further embodiment, the oligonucleotides of the
invention can be coupled to a so called "delivery molecule" which
imparts a specific cellular uptake or targeting property to the
attached immunomodulatory oligonucleotides.
[0117] Commonly used examples of such include but are not limited
to hydrophobic molecules like cholesterol functional groups,
specific peptides that have an increased ability to translocate
cellular membranes such as cationic antimicrobial peptides or
commonly recognized protein transduction domains (PTDs) or DNA
vectors.
[0118] When given in combination with an immunotherapy, the
inventive compounds are preferably administered in advance of said
immunotherapy, preferably about 6, about 12, about 24, or about 48
hours in advance of the therapy. The inventive compounds may also
be administered longer before the therapy, for example about 3
days, or about 5, 7, or 14 days before said therapy.
[0119] When given in combination with an immunological therapy, and
in particular a therapy involving the administration of an
antibody, the inventive compound is preferably administered before
the administration of the antibody to the patient, and most
preferably sufficiently before in order to allow for the
up-regulation of cell surface molecules or cell surface markers
towards which the specific antibody is targeted. The treatment is
preferably an immunological therapy involving the administration of
an antibody to the patient.
[0120] Another embodiment of the invention would be to repeat the
pre-treatment with oligonucleotides according to the invention to
boost the effect and thereby increasing the efficacy of an
immunotherapy further.
[0121] A preferred embodiment of the invention comprises the use as
defined above, wherein antibody-therapy is administered before,
after or essentially simultaneously with the administration of said
oligonucleotide. This treatment is chosen among immunological
therapy, treatment with antibodies, steroids, cortisone treatment,
interferon treatment, or a combination of any of these.
[0122] Consequently the present invention also comprises a method
for the treatment of said diseases and disorders wherein an
isolated oligonucleotide sequence according to any one of the
sequences presented in Table 1 (SEQ ID NO. 1-8) is administered to
a patient in need thereof.
[0123] In any one of the above embodiments of the invention, said
oligonucleotide is administered in a dose effective to elicit or
increase or up-regulate the expression of at least one cell surface
molecule or cell surface antigen, in particular a cell surface
marker chosen among CD20, CD23, CD69 and CD80.
[0124] A pharmaceutical composition, wherein the oligonucleotide is
chosen from one of SEQ ID NO. 1, SEQ ID NO. 4 and SEQ ID NO. 7 and
SEQ ID NO. 8 [IDX9022; IDX9058; IDX0150; IDX0505].
[0125] The use of the pharmaceutical composition, wherein the
oligonucleotide is SEQ ID NO. 1 [IDX9022].
[0126] Another embodiment of the invention is a method for the
treatment, and/or enhancement of a treatment, wherein an
oligonucleotide according to SEQ ID NO. 1-8 (Table 1) is
administered in a dose effective to induce the endogenous
production of at least one cytokine and the up-regulation of the
expression of one or more of the cell surface antigens CD20, CD23,
CD69 and CD80.
[0127] Another embodiment of the invention is a method for the
treatment, and/or enhancement of a treatment, wherein a
pharmaceutical composition containing any one of the
oligonucleotides presented in Table 1, wherein the composition is
administered to a patient.
[0128] CD targeted therapies are treatments that include antibody
treatments, as well as up/down regulation of CD antigens at the
cell surface. A skilled person is well aware of the fact that there
are several approaches to the treatment of B-cell associated
diseases. Naturally new approaches are constantly being developed,
and it is conceived that the oligonucleotides, their use and
methods of treatment according to the present invention, will find
utility also in combination with future treatments. The inventive
oligonucleotides will have utility in combination with existing or
future immunotherapies.
[0129] The embodiments of the invention have many advantages. So
far, the administration of an oligonucleotide in the doses defined
by the inventors has not elicited any noticeable side-effects.
Further, the mucosal administration is easy, fast, and painless,
and surprisingly results in a systemic effect. It is held that this
effect, either alone, or in combination with existing and future
treatments of said diseases, offers a promising approach to fight
these diseases as well as related diseases.
EXAMPLES
1. The Effects of IDX-Compounds on the Surface Expression of CD20
on PBMCs from Chronic Lymphocytic Leukemia (CLL) Patients and
Combination Treatment of CLL Cells with IDX-Compounds Followed by
Rituximab
Materials and Methods
Test Compounds
[0130] In total, 8 IDX-compounds (SEQ ID NO. 1-8 Table 1) were
investigated for their effects on the cell surface expression of
CD20, CD23 and CD80 on CD19+ cells in PBMCs isolated from CLL
patients. All IDX-compounds were also investigated for their effect
on activation of NK-cells by studying the expression of CD69 on
CD3-/CD56+ cells. All IDX-compounds were synthesized by Biomers.net
(Ulm, Germany) except IDX0150 which was ordered from Avecia
(Massachusetts, USA).
Formulation
[0131] The IDX-compounds were adjusted with phosphate buffered
saline (PBS, Invitrogen, Carlsbad, Calif.) to reach a stock
concentration of 500 .mu.M by aid of UV spectrophotometry
(SmartSpec.RTM. 3000, BIO-RAD, Hercules, USA) and stored at
-20.degree. C. until used.
Cells
[0132] Heparinized peripheral blood was obtained after informed
consent from patients diagnosed with B-CLL with significant
circulating disease. All patients were diagnosed by routine
immunophenotypic, morphologic and clinical criteria.
[0133] The mononuclear cell fraction was isolated by Ficoll-Hypaque
(Seromed, Berlin, Germany) gradient centrifugation. The isolated
cells were immediately incubated at 37.degree. C. in RPMI-medium
supplemented with 10% FCS, 1% PenStrep, 2 mM L-glutamine, 10 mM
HEPES and 1 mM Sodium Pyruvate.
Antibodies and Chemicals
[0134] Fluorochrome conjugated (Allophycocyanin (APC),
R-phycoerythrin (PE)) antibodies, mouse anti-human CD19-PE-Cy7,
CD20-APC-Cy7, CD23-APC, CD80-PE, CD3-APC, CD56-PE and CD69-PE-Cy7
and isotypes IgG1,.kappa.-PE-Cy7 and IgG2b,.kappa.-APC were
obtained commercially from BD Biosciences (New Jersey, USA).
Cell Treatment
[0135] Freshly isolated CLL cells were treated with 1, 10 and 25
.mu.M of each of 8 different IDX-compounds in 500 .mu.l of assay
medium at a concentration of 2.times.10.sup.6 cells/ml in 48-well
plates, or in 200 .mu.l in 96-well plates.
FACS Analysis
[0136] After 48 hrs of incubation with the IDX-compounds, 200 .mu.l
of the cells were spun down in 96-well plates, re-suspended in 100
.mu.l of 2% FCS (in PBS) and incubated with two sets of mixed
fluorochrome conjugated antibodies against CD19, CD20, CD23, CD69,
CD80, CD3 and CD56, for 30 min at 4.degree. C. The cells were then
washed twice in pure PBS and subsequently analyzed by FACS using a
FACSArray bioanalyzer for surface antigen expression analysis.
[0137] Before incubation, a fraction of the freshly isolated CLL
cells were stained with the two previously described antibody mixes
for direct analysis of surface antigen expression by FACS.
ADCC Assay
[0138] For combinatory treatment cells were treated with IDX0011,
IDX9022, IDX9058, IDX0150 or IDX0505 for 48 hrs. The cells were
then washed twice with PBS and rituximab (Roche Pharmaceuticals)
was added at a final concentration of 5 or 10 .mu.g/ml. The cells
were incubated for 30 min at 37.degree. C. whereafter a F(ab')2
fragment (Jackson Immunoresearch, Baltimore, USA) was added as a
crosslinker and the cells were incubated again at 37.degree. C.
After 24 hrs the cells were harvested for apoptosis analysis by
FACS.
[0139] CDC Assay
[0140] For combinatory treatment cells were treated with the above
mentioned IDX-compounds for 48 hrs. The cells were then washed
twice with PBS and incubated for 4 hrs with 30% human serum and
rituximab (at 5 or 10 .mu.g/ml) in RPMI media. Heat-inactivated
human serum was used as control wells. After 4 hrs cells were
harvested for apoptosis analysis by FACS.
Apoptosis Assay
[0141] After 3 days from day 0, the cells were harvested for
apoptosis analysis. The cells were spun down in 96-well plates,
re-supended in 2% FCS as above and incubated with an antibody mix
of CD19 and CD3 (BD Biosciences) for 30 min at 4.degree. C. The
cells were washed twice with PBS and subsequently stained with
Annexin V and 7-AAD (BD Biosciences) for 10 min at RT for analysis
of early and late apoptosis, respectively. The cells were analyzed
by flow cytometry as above.
Cytometric Bead Array
[0142] Human CLL-PBMCs were treated with IDX-compounds for 48 hrs
and the expression of cytokines was analyzed using the cytometric
bead array (CBA) Flex kit (BD Biosciences). Columns represent means
of the expression in pg/ml and standard deviations in cells from 6
patients in FIG. 1e, 5 patients in FIG. 1f and 4 patients in FIG.
1g.
[0143] IL-6, IL-10, TNF-.alpha., IFN-.gamma. and IP-10 cytokines
were measured utilizing the CBA Flex kit, according to the
manufacturer's protocol. The samples were analyzed using a
FACSArray flow cytometer and subsequently quantified using the FCAP
Array software (BD Biosciences). The lower detection limit was 20
pg/ml for each cytokine.
Results
[0144] CpG oligonucleotides affect innate and adaptive immune
responses including antigen presentation, co-stimulatory molecule
expression and induction of cytokines, which makes them interesting
therapeutic tools for use in different disease contexts. Most of
the information on the immunobiology of CpG oligonucleotides has
been derived from studies with human PBMCs or mouse spleen cells,
which constitute reliable sources of large numbers of immune cells
to use as model systems. In this study we investigated the effect
of IDX-compounds on the expression of CD20 on B-cells using PBMCs
from patients diagnosed with CLL.
[0145] In order to make antibody drugs more efficient, an
up-regulation of the specific antigen targets on the surface of
tumor cells could be helpful. One way of obtaining such an effect
could be to stimulate the cells with CpG oligonucleotides. CpG-ODNs
have highly immunostimulatory effects on human and murine
leukocytes, inducing B-cell proliferation; cytokine and
immunoglobulin secretion; natural killer (NK) cell lytic activity
and IFN-gamma secretion. In addition, CpG-ODNs activate dendritic
cells (DCs) and other antigen presenting cells, leading to
expression of co-stimulatory molecules and secretion of cytokines,
especially the Th1-like cytokines that are important in promoting
the development of Th1-like T cell responses (Krieg et al, 1995 and
2006). The increase in receptor density by CpG-ODNs could be
mediated through a direct effect of the oligonucloetides on the
cells, or through the induction of cytokines. An increase in
antigen density or an increase in the population of cells
expressing the target receptors would enable the antibodies to kill
the tumor cells more efficiently, either through enhancing
antibody-dependent cellular cytotoxicity (ADCC) or
complement-dependent cytotoxicity (CDC).
[0146] Treatment of the cells with IDX-compounds increased the
number of CD19+ cells expressing CD20 as well as the mean
fluorescence intensity (MFI) of CD20, i.e. the amount of CD20
expressed per cell (FIG. 1a). The largest increase of CD20
expression was induced by IDX-compounds IDX9022 (SEQ ID NO. 1,
Table 1), IDX9071 (SEQ ID NO. 5, Table 1) and IDX0150 (SEQ ID NO.
7, Table 1) (FIG. 1a). IDX0505 (SEQ ID NO. 8, Table 1), which
instead of a CG contains a GC, also induced CD20 expression but at
lower levels (FIG. 1a).
[0147] For most of the IDX-compounds tested there was a
dose-response induction of CD20, with the most enhancement observed
at 10 or 25 .mu.M, and less induction at 1 .mu.M (FIG. 1a). The
IDX-compounds that were shown to be most efficient in up-regulating
CD20 all have in common that they are potent inducers of IL-6 and
IL-10 (FIGS. 1e and f). IL-6 and IL-10 are released from activated
B-cells in response to IDX-compounds, and this indicates that
IDX-compounds that are potent activators of B-cell cytokine release
also are efficient in up-regulating CD20.
[0148] Treatment of the cells with IDX-compounds increased the
number of CD19+ cells expressing CD23 as well as the MFI of CD23
(FIG. 1b). The largest increase of CD23 expression was induced by
IDX-compounds IDX9038 (SEQ ID NO. 2, Table 1), IDX9052 (SEQ ID NO.
3, Table 1) and IDX9071 (SEQ ID NO. 5) (FIG. 1b). The
oligonucleotide IDX0505 (SEQ ID NO. 8, Table 1), which instead of a
CG contains a GC, was a poor inducer of CD23 (FIG. 1b).
[0149] For most of the IDX-compounds tested there was a
dose-response induction of CD23, with the highest up-regulation
observed at 25 .mu.M, and less induction at 1 and 10 .mu.M (FIG.
1b). As for CD20, the IDX-compounds that were shown to be most
efficient in up-regulating CD23 all have in common that they are
potent inducers of IL-6 and IL-10 (FIGS. 1e and f). In addition,
IDX9038 and IDX9052 also induce IFN-alpha which is known to inhibit
B-cells proliferation in vitro. The production of IL-6 and IL-10
might abolish this effect.
[0150] Treatment of CLL cells with IDX-compounds enhance the
expression of CD23 on the cell surface of CD19+B-cells, which
subsequently could enhance apoptosis of B-CLL cells induced by
lumiliximab.
[0151] CD80 (also referred to as B7-1) is an important immune
accessory molecule expressed on antigen presenting cells.
Phenotypic studies of human CLL cells demonstrated that CLL cells
express little or no CD80 (data not shown).
[0152] Treatment of the CLL cells with IDX-compounds increased the
number of CD19+ cells expressing CD80 as well as the MFI of CD80
(FIG. 1c). The largest increase of CD80 expression was induced by
IDX-compound IDX9058 (SEQ ID NO. 4, Table 1) (FIG. 1c). The
IDX-compounds IDX0150 and IDX0505 (SEQ ID NO. 7 and 8, Table 1)
also induced considerable amounts of CD80 expression (FIG. 1c).
[0153] For most of the IDX-compounds tested there was a
dose-response induction of CD80 in B-cells from CLL patients, with
the most enhancement observed at 10 or 25 .mu.M, and less induction
seen at 1 .mu.M (FIG. 1c). In addition, the IDX-compounds that were
shown to be most efficient in up-regulating CD80 on the CLL B-cells
all have in common that they are potent inducers of IL-6 and IL-10
(FIGS. 1e and f) in accordance with the results presented in
example 1.
[0154] Galiximab seems to induce apoptosis of tumor cells through
mechanisms similar to rituximab. Thus, there is good reason to
believe that an up-regulation of CD80 surface expression might
enhance galiximab-induced apoptosis of B-CLL cells.
[0155] All IDX-compounds induced activation of NK-cells as seen by
an increased number of CD3-/CD56+ cells expressing CD69 (FIG. 1d).
The strongest activation of NK cells was observed byIDX-compounds
IDX9022 (SEQ ID NO. 1, Table 1) IDX9038 (SEQ ID NO. 2), IDX9058
(SEQ ID NO. 4, Table 1) as well as IDX0150 (SEQ ID NO. 7, Table 1)
and IDX0505 (SEQ ID NO. 8, Table 1).
[0156] When cells were treated with rituximab after IDX-treatment,
there was a marked increase in apoptosis of B-cells mediated
through ADCC (FIG. 3a). There was no increase in death of B-cells
mediated through CDC (data not shown). The increase in ADCC
corresponded well with the observed increase in CD20 expression as
well as an increase in the activation of NK-cells. The IDX-compound
that induced the highest levels of CD20 was IDX9022 (SEQ ID NO. 1)
at 10 .mu.M. Cells stimulated with 1 uM of IDX9022 showed a minor
increase of ADCC when treated with rituximab, whereas cells
pretreated with 10 .mu.M of IDX9022 displayed a significant
increase of ADCC (FIG. 3a). IDX0150 (SEQ ID NO. 7, Table 1),
IDX0505 (SEQ ID NO. 8, Table 1) and IDX9058 (SEQ ID NO. 4, Table
1), were all almost as efficient as IDX9022 in enhancing
rituximab-induced ADCC (FIGS. 3c-e, respectively), while IDX0011
did not enhance ADCC (FIG. 30. NK-cells are important effector
cells for ADCC to take place and the activation of these goes well
in hand with the observed increase in ADCC. The enhancement of ADCC
is a desired effect in the treatment of hematologic malignancies.
ADCC is more efficient in eradicating tumor cells, whereas CDC is
less efficient and often associated with undesired side effects for
the patient.
[0157] The order of drugs is also of importance. In a reverse
experiment, cells were treated with rituximab for 48 hrs and
subsequently treated with IDX-compounds for another 24 hrs. This
order of combination treatment did not result in enhanced ADCC
(FIG. 3b). These results shows that an up-regulation of CD20 is
necessary for the combination treatment to be effective. In
previous clinical trials NHL patients have been treated with
rituximab before treatment with CpG-ODNs and in these patients
clinical response was not improved by the addition of CpG-ODNs. In
order for the combination treatment to be efficient, patients
should be treated with IDX-compounds 1 or 2 days before treatment
with rituximab.
[0158] Treatment of CLL cells with IDX-compounds enhances the
expression of CD20 on the cell surface of CD19+ B-cells as well as
the activation of NK cells. Both these effects are important steps
in enhancing the observed rituximab-mediated ADCC of malignant
B-CLL cells.
2. Receptor Expression in Pbmcs Isolated from MS Patients
Materials and Methods
[0159] PBMCs from remitting-relapsing multiple sclerosis (RRMS)
patients (n=2) were obtained using BD Vacutainer.RTM. CPT.TM. Cell
Preparation Tubes (BD Biosciences). The cells were immediately
incubated at 37.degree. C. in a volume of 500 .mu.l of complete
RPMI-medium (containing 10% FCS, 1% PenStrep, 2 mM L-glutamine, 10
mM HEPES and 1 mM Sodium Pyruvate) in 48-well plates at a conc. of
2.times.10.sup.6 cells/ml and treated with 1, 10 and 25 .mu.M of
IDX9022. A fraction of the cells were stained CD19-PE-Cy7 and
CD20-APC-Cy7 for direct analysis of surface antigen expression by
FACS.
[0160] After 48 hrs, 200 .mu.l of the cells were spun down in
96-well plates, re-suspended in 100 .mu.l of 2% FCS (in PBS) and
incubated with antibodies against CD19 and CD20 for 30 min at
4.degree. C. The cells were then washed twice in pure PBS and
subsequently analyzed by FACS using a FACS Array bioanalyzer for
surface antigen expression analysis.
Results
[0161] Both patients showed increased expression of CD20 upon
stimulation with IDX9022 in a dose-dependent manner as shown in
FIG. 2.
[0162] An increased CD20 expression was observed in PBMCs treated
with the inventive compound. The inventors expect these properties
of the oligonucleotide compound to be useful as alternative
therapies in RRMS patients, i.e. the enhancement of antibody
therapy.
3. Pulse Treatment of PBMCs Purified from Whole Blood from CLL
Patients
Material and Methods
[0163] IDX-compounds IDX9022 (SEQ ID NO. 1, Table 1) and IDX0150
(SEQ ID NO. 7, Table 1) were investigated for their effects on cell
surface expression of CD20, CD23 and CD80 on CD19+ cells after
pulsed treatment of CLL-PBMCs.
[0164] PBMCs were prepared from fresh CLL-blood and incubated in
supplemented RPMI-1640 medium in 96-well plates as previously
described for CLL-PBMCs. Cells were treated for 2 hrs, 6 hrs or 24
hrs with IDX9022 and IDX1050 at the following final concentrations:
0.1, 1, 10 or 25 .mu.M. After indicated time points, cells were
washed with medium twice. After the last wash the cells were
resuspended in 0.2 ml medium and re-incubated at 37.degree. C. For
comparison selected wells were treated with IDX0150 or IDX9022
until the experiment was finished at 72 hrs or left untreated.
After 72 hrs cells were harvested and analyzed for cell surface
marker expression by FACS analysis as previously described.
Results Pulse Experiment CD20
[0165] PBMCs were purified from whole blood from four individual
CLL-patients and treated with selected IDX-compounds. Pulsed
treatment of the cells resulted in an increased number of CD20
positive cells, especially at the higher concentrations of both
compounds (10 and 25 .mu.M, FIG. 4a). Overall, the longer period
the cells were incubated with IDX-compounds, the more cells became
CD20 positive compared to untreated cells (FIG. 4a). IDX-compound
IDX9022 appear to be the most efficient of the two compounds in
increasing the number of CD20 expressing B cells, since treatment
of the cells for two hours, followed by wash and subsequent
incubation, resulted in more CD20 positive cells than equivalent
two hours treatment with IDX0150. Prolonged incubation period with
10 or 25 .mu.M of IDX9022 induced the highest number of CD20
positive cells and corresponded with the strongest MFI-increase
(data not shown). The highest numbers of CD20 positive cells
obtained by IDX0150-treatment were observed when the cells were
incubated with 25 .mu.M for 72 hrs. Pulse treatment with either
IDX-compound did not induce a strong increase in CD20 MFI (data not
shown).
[0166] Pulsed treatment of CLL-PBMCs with IDX-compounds IDX0150 and
IDX9022 resulted in increased surface expression CD23 (FIG. 4b).
Overall, it seems the more IDX-compound and the longer the
incubation period, the more CD23 was expressed compared to
untreated cells.
[0167] IDX9022 appear to be the most efficient of the two
IDX-compounds in increasing CD23, since pulsing the cells for two
hours resulted in strong up-regulation of CD23, which was not
observed following treatment with IDX0150 (FIG. 4b). IDX9022 also
induced the highest number of CD23 positive cells compared to
IDX0150. The highest increase in CD23 MFI after treatment with
IDX0150 was observed after 24 hrs incubation, or when cells were
harvested for flow cytometry staining after 72 hrs of treatment
(FIG. 4b).
[0168] Pulsed treatment of PBMCs purified from CLL-blood with the
two selected IDX-compounds resulted in increased CD80 surface
expression (FIG. 4c). The longer period the cells were incubated
with the IDX-compounds, the more CD80 was induced compared to
untreated cells (FIG. 4c), which could be due to that a longer
incubation time allows for more IDX-compounds to be taken up by the
cells, and consequently more IDX-compounds will interact with
TLR9.
[0169] IDX9022 appears to be the most efficient of the two
IDX-compounds tested in increasing CD80, since pulsing the cells
for two hours resulted in up-regulation of CD80, while two hours
pulse treatment with IDX0150 did not (FIG. 4c). Long incubation
periods with 10 .mu.M of IDX9022 induced the highest percentage of
CD80 positive B-cells as well as a stronger MFI-increase compared
to IDX0150. The highest increase of CD80 surface expression after
IDX0150-treatment was observed when cells were incubated with 25
.mu.M of the compound throughout the experiment, i.e. for 72 hrs
(FIG. 4c).
[0170] The results show that there is a time dependent induction of
CD80 in response to the inventive compounds. An increased surface
expression of CD80 was seen in CLL B-cells already after 2 hrs of
incubation with IDX9022. The highest levels of CD80 were induced
with incubation periods of 24 hrs or more.
[0171] Although the invention has been described with regard to its
preferred embodiments, which constitute the best mode presently
known to the inventor, it should be understood that various changes
and modifications as would be obvious to one having the ordinary
skill in this art may be made without departing from the scope of
the invention as set forth in the claims appended hereto.
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Koretzky G A, Klinman D M. CpG motifs in bacterial DNA trigger
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[0174] Krieg A. M. Therapeutic potential of Toll-like receptor 9
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Sequence CWU 1
1
8122DNAArtificial SequenceSynthesized 1tcgtcgttct gccatcgtcg tt
22221DNAArtificial SequenceSynthesized 2tcgtcgttcg gccgatcgtc c
21314DNAArtificial SequenceSynthesized 3ggggtcgtct gcgg
14416DNAArtificial SequenceSynthesized 4gatcgtccgt cggggg
16521DNAArtificial SequenceSynthesized 5tcgttcgtct gcttgttcgt c
21624DNAArtificial SequenceSynthesized 6ccggggtcgc agctgagccc acgg
24719DNAArtificial SequenceSynthesized 7ggaacagttc gtccatggc
19819DNAArtificial SequenceSynthesized 8ggaacagttg ctccatggc 19
* * * * *